This commentary paper (2017) proposes that connectedness is the key to its therapeutic potential.

Abstract

“Psychedelic drugs are creating ripples in psychiatry as evidence accumulates of their therapeutic potential. An important question remains unresolved however: how are psychedelics effective? We propose that a sense of connectedness is key, provide some preliminary evidence to support this, and suggest a roadmap for testing it further.”

Authors: Robin L. Carhart-Harris, David Erritzoe, Eline C. H. M. Haijen, Mendel Kaelen & Rosalind Watts

Notes

The impetus for this paper comes from but a conference (Psychedelic Science) and a paper by Watts and colleagues in 2017. Of the patient that had success with psilocybin-assisted psychotherapy for treatment-resistant depression (TRD), all noted that a renewed sense of connectedness was one of the changes in their lives (and thus is a mediator for the therapeutic effect).

The argument put forth in the commentary is that connectedness may be the big underlying factor of why psychedelic-assisted psychotherapy works (versus mystical experience, ego dissolution).

Connectedness is divided into three sub-scales, connection to 1) self, 2) others, and 3) the world. The first of which, the authors hypothesize is the most important and necessary for the other two to have an effect.

A connection is also made between the mystical experience questionnaire (MEQ) of which one subscale is closely related to connectedness. The same goes for ego-dissolution where unitive experience can be likened to connectedness (to all three subscales). Or put the other way around, the ego (inflation) can be seen as the antipode of connectedness.

At the brain-level, there has been some work on looking at the signature of ego-dissolution/unitive experience (Tagliazucchi et al., 2016) so that could lay the groundwork for measuring (acute) connectedness at this level too.

The paper ends with an intention to develop an operational definition of connectedness. One that is not subjective but has a biological basis and has specific behavior associated with it that can be measured.

Another paper (Hendricks, 2018) proposes that the concept of awe is an underlying mechanism why psychedelics work.

Summary

Psychedelics and Connectedness

We are in the midst of a cultural zeitgeist with regard to psychedelic drugs, with former director of the National Institute for Mental Health and past president of the American Psychiatric Association speaking enthusiastically about the field.

The theme of connectedness was pervasive at Psychedelic Science, and was first given clear emphasis in psychedelic therapy by Watts et al. 2017. Participants made reference to one particular mediating factor: a renewed sense of connection or connectedness.

Asenseofdisconnection is a feature of many major psychiatric disorders, particularly depression, and a sense of connection is considered a key mediator of psychological well-being. Psychedelics have shown promise in the treatment of depression, addictions, anxiety and obsessive-compulsive disorder.

Like any construct in psychology, connectedness requires validation work. There already exist validated measures of connectedness to others and to nature, and new measures could be easily devised and developed.

We are collecting longitudinal data on social connectedness in individuals who plan a psychedelic experience and provide web-based survey data on the process. We suspect that increased connectedness is a principal component of post-psychedelic therapeutic change.

As noted above, connection to others and the world follows naturally from connection to the self. The connection-to-self stage is a bedrock from which connection to others and the world can follow most naturally.

We feel that a new connectedness scale is needed that incorporates the three sub-factors identified in our recent qualitative analysis. This scale could be used to test the hypothesis that psychedelics are associated with connectedness that does not exist for other psychoactive drugs.

Despite previous expressed concerns regarding the construct of mystical experience, psychedelic-induced mystical experiences have been found to predict long-term increases in psychological well-being and clinical improvements after psychedelic therapy.

In 1960, philosopher Walter Stace referred to the ‘unitive experience’ as the core hallmark of the mystical experience. We recently found that scores on the psychedelic-induced unitive experience questionnaire correlate highly with scores on the ‘ego-dissolution inventory’.

The Psychedelic Research Group at Imperial College London has focused on better understanding the brain mechanisms of psychedelics, including their putative therapeutic actions. Psychological mechanisms are at least as important as brain imaging, and offer a level of explanation that is closer to the lived-experience.

Our work on the neural correlates of ego-dissolution may be considered part of a progressive initiative to demystify the psychedelic experience. It is unclear whether the psychedelic experience leaves a lasting memory trace or causes lasting anatomical and/or functional brain changes.

We can discuss high-level constructs such as ‘connectedness’ while knowing that psychedelics activate serotonin 2A receptors. This suggests that serotonin 2A receptor signalling mediates a state of rapid plasticity that is conducive to major change.